This patient is complaining of _.You will need to take off jewelry that might be in the way of the X-ray picture. In Figure 3-8B, crisscross the superimposed lungs and costophrenic angles (E). Return to the trachea and work your way down the mediastinum (D). Continue up the lower spine (B), searching the soft tissues and bones posteriorly, then anteriorly (C). In Figure 3-8A, start by searching below the diaphragm (A). Don’t ignore it! The search pattern is identical (ATMLL). The lateral is a valuable but often ignored radiograph. In searching the lungs, three helpful strategies to minimize oversights are (1) searching the lungs individually, (2) searching the lungs _, and (3) taking advantage of _, if available. In Figure 3-7B, obtained 1 year earlier than the x-ray in Figure 3-7A, the nodule was barely visible ( arrows ).įor the novice, subtle and not so subtle abnormalities are easy to miss. They help you detect new disease and evaluate for change in preexisting disease. Radiologists always look at old films when available.
Right midlung laterally, over fourth anterior rib (Who said this would be easy?)ĬLINICAL PEARL: The old x-ray is your best friend. The change should be obvious (it is to me anyway). See anything abnormal in Figure 3-7A ? The abnormality is subtle. Practice this search pattern in Figure 3-7A. This also should give you a second look at costophrenic angles and the hilum. The second look involves a side-by-side comparison of the lungs ( Figure 3-6B ). Start in the right costophrenic angle (*) as outlined in Figure 3-6A, examining the right and then left lung. The lungs are so important that we search them twice. Lungs: Most chest x-rays are ordered to evaluate lung disease, so the lungs are examined last. Test yourself on Figure 3-5B by identifying the following structures: Note that the posterior ribs (B) tend to be horizontal, while the anterior ribs descend from lateral to medial (E). These structures are represented in Figure 3-5B. Finish by reversing the order down the left side. Thorax: In Figure 3-5A, start at the right base (*), looking at the soft tissues (e.g., muscles, breast) of the chest wall, the ribs, and the shoulder girdle in sequence. Test yourself on Figure 3-4C by identifying the following structures: Figures 3-4A and 3-4B show three rapid searches of the mediastinum: A = for the trachea and carina B = for the aorta and heart C = for the hilum. Start with a global look at the mediastinum for contour abnormalities (i.e., focal or diffuse widening). Mediastinum: An organized search of the mediastinum is complicated because there are multiple overlapping structures. Similarly, basilar lung disease (pneumonia, pleurisy) may mimic upper abdominal disease. The higher diaphragm is the _.ĬLINICAL PEARL: Upper abdominal disease (subphrenic abscess, perforated viscus, pancreatitis, and cholecystitis) may mimic lung disease clinically. The homogeneous density below the right diaphragm = _. The gas collection just below the heart = _. The hepatic flexure and the spleen may be visible. Normal gas-containing structures are the stomach and the splenic flexure of the colon. A helpful mnemonic is Are There Many Lung Lesions (ATMLL)?Īrrange the following in viewing sequence:Ībdomen: In Figure 3-3A, start in the right upper quadrant (*) and scan across the upper abdomen several times. Look at each lung individually, then compare left lung and right lung. For the chest x-ray, start in the upper abdomen, then look at the thoracic cage (soft tissues and bones), then the mediastinal structures, and finally the lung. You are less likely to miss secondary but important findings this way. Start reading every radiograph-chest or otherwise-by scanning the areas of least interest first, working toward the more important areas. To maximize your accuracy, you must have an organized search pattern.
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